How to treat skin tears

In this section, you’ll learn:

How to treat skin tears

When you treat a skin tear, you should have three main goals:¹

Preserve the skin flap and maintain the surrounding tissue;
Re-approximate the wound edges (without stretching the skin); and
Reduce the risk of infection and further injury.

The Skin Tear Decision Algorithm will help you to do that.¹

Using the Skin Tear Decision Algorithm

To treat a skin tear, follow these five steps:¹

Step 1: Assess the wound. Be sure to control the bleeding.

TIP: The Triangle of Wound Assessment can be a useful tool to help you conduct a holistic wound assessment.

Step 2: Cleanse the wound.

Step 3: Approximate the wound edges. Find out which type of skin tear it is, using the classification system. Be sure to measure and document the wound.

Step 4: Set out your treatment goals. This would include:

treating the cause;
implementing the prevention protocol;
using moist wound healing;
avoiding trauma;
protecting the periwound skin;
managing exudate;
avoiding infection; and
controlling the pain.

Step 5: Choose your treatment option. You should base your choice on the type of skin tear your patient has.

Choosing the right dressing

Table 1 outlines different dressing options based on the skin tear type.

Working with dressings

There are some basic tips you can follow with all dressings that will help protect your patient’s skin and promote wound healing. Try:¹

marking the dressing with an arrow so it’s clear which way it should be removed.
using an adhesive remover when you remove the dressing. This will minimise trauma.
removing the dressing slowly.
using a skin barrier product to protect the surrounding skin.
using an emollient to soften and smooth the skin around the wound. This will help prevent additional tearing.

NOTE: You should continue to monitor the wound for changes or signs of infection. If the wound doesn’t improve (e.g. after four assessments) or if it gets worse, refer your patient to an appropriate specialist.¹

If your patient has fragile skin

When your patient has vulnerable skin, you want to select a dressing that:¹

controls bleeding;
is easy to put on and take off;
doesn’t cause trauma when you remove it;
optimises the healing environment;
allows for an extended wear time;
is non-toxic; and
is flexible and molds to the shape of the wound.

Table 1: Dressing selection guide¹

Dressing type	Skin tear type	When to use it	What to keep in mind
Foam dressing	2, 3	With wounds that have moderate exudate, or where the patient will have the dressing on for a longer period of time (2-7 days, depending on the level of exudate)	Use a non-adhesive version when possible. This will help to avoid damage to the surrounding (periwound) skin. Note: Doesn’t apply to silicone border products.
Calcium alginates	1, 2, 3	With wounds that have moderate to heavy exudate. This type of dressing can also help stop minor bleeding (i.e.is haemostatic).	Can dry out the wound bed if the exudate level isn’t high enough. You need to use a secondary cover dressing with this type of dressing.
Gelling fibres	2, 3	With wounds that have moderate to heavy exudate.	These dressings don’t have any haemostatic properties. They can dry out the wound bed if the exudate level isn’t high enough. You also need to use a secondary cover dressing with this type of dressing.

Additional treatment options

Wound closure strips can be an effective treatment to bring the wound edges together. By using these strips, you can close the wound without creating tissue tension.² Compression therapy can also be effective when treating skin tears. It helps reduces the harmful effects of oedema (i.e. fluid accumulation in the tissues surrounding the wound).² It also decreases the risk of blood clots forming (deep venous thrombosis).^3,4 You can use compression therapy on most traumatic wounds.

References

ISTAP Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin 2018
Acute Wounds. Identification, assessment and management of acute wounds. Coloplast HEAL course.
Sachdeva, A., Dalton, M., Amaragiri, S.V., Lees, T. (2010). Elastic compression stockings for prevention of deep venous thrombosis. Cochrane database of Systematic review(7), 1-55.
Sachdeva, A., Dalton, M., Amaragiri, S.V., Lees, T. (2014). Graduated compression stockings for prevention of deep vein thrombosis (review). Cochrane database, Cochrane database of systematic reviews 2014(12).